Taking a Pump Vacation

Right now, I'm on vacation. To be more specific, I'm on an insulin pump vacation.

Which, to be honest, it's not much of a vacation (still have the ole diabetes to contend with!).

What is a pump vacation? It's taking a break from wearing an insulin pump for short period of time. I'm not switching back to shots permanently, although I do know of people who have done so after taking a pump vacation. Sometimes it's done because absorption isn't working well due to overused skin "real estate"; sometimes it's done seasonally (the freedom to wear dresses and skimpy bathing suits, for example); and sometimes it's done in advance to prevent damage to an insulin pump, like for a rafting trip. Some people even do it every weekend!

As it turns out, the exact same weekend that my insulin pump broke, the insulin pump of my friend, Katie Clark, also broke! She signed up for a pump vacation, taking a respite from technology in favor of injections. When my new insulin pump arrived, I decided to take a cue from Katie and delay my pump hook-up a little longer in favor of a pump vacation.

With the summer season around the corner, I started thinking that others might be considering a pump vacation and I want to share my experiences thus far.

I should note that this is not my first pump vacation. In 2007, I spent four months attempting to do Dr. Steve Edelman's "untethered" regime, but it didn't work as well for me. Going "untethered" means using Lantus and using the insulin pump only for corrections and meal boluses. It's good for people who don't want to wear a "tethered" insulin pump, and who aren't sold on the patch pump either (at the time, patch pumps weren't even on the market!). For reasons unknown, I felt that being unplugged caused me to absorb insulin poorly, possibly from disconnecting so many times. My 2007 experiment lasted only a few months. I'm not entirely sure how long this 2012 experiment will last.

What I Like About MDI (Multiple Daily Injections)

I like not having something stuck to me. I have worn an insulin pump for 12 years straight, aside from that brief respite in 2007. It's not that I'm anti-tubing, but sometimes I'm just anti-technology. I don't always like feeling like a Borg. Most of the time it doesn't bother me, but every so often, having this "thing" hanging on me is just annoying. As soon as I switched to MDI, I reflexively tried to unclip my pump from my clothes before changing into my PJs. It really has become a part of me, but I won't lie, I sometimes hate it.

One thing that's changed is that I'm testing my blood sugars more often. Crazy, huh? People always say that you need to test more on the pump because you don't have any long-acting insulin in your system — so if something goes wrong with the pump, your BG level will skyrocket much faster. For me, changing up my routine has reinvigorated my commitment to test more often.

And I now take my insulin before my meal. I know I'm not the only one who struggles with this. I always thought having my insulin pump so close to me would make taking insulin on time easier. But that hasn't been the case. I'm a chronic "after meal" boluser, and that habit hasn't helped me.

Now, on Lantus, I keep my insulin and my glucose meter together in one case. I first test my blood sugar, figure out what's for dinner (which usually involves asking my husband, the family chef), and then shoot up. Then I put the case away and I don't have to look at it again.

Finally, I have more real estate to work with. There are some places that a pump set just won't work. It's much easier to rotate areas where I can inject on Lantus, and hopefully heal up some scar tissues that I've built over the last decade.

What I Miss About the Insulin Pump

I hate injections. Having to poke myself several times a day is just annoying. It's probably helped my eating a bit, since I'm less likely to want to inject for that extra cookie or apple, but that's also an annoyance. In the battle between injections and insulin pumps, insulin pumps win in the "ease of use" department, hands down. Plus, I bruise and mark easily. I have a nasty bruise on my abdomen that is just ugly and makes me feel at least as unsexy as wearing an insulin pump set.

I miss the precision of basal rates. On an insulin pump, you have all kinds of opportunities to automatically give yourself more or less insulin through changing your basal rates. On Lantus, you're kind of stuck with a flat line. In switching from the pump to Lantus, I can see how my body uses insulin differently throughout the day even more clearly, with some clear effects like the dawn phenomenon. I have increased my bedtime Lantus (I have my dose split) by three units and I'm still waking up over 200 mg/dl! What gives?

When I talked with my CDE, Gary Scheiner, author of Think Like a Pancreas and founder of Integrated Diabetes Services, about my adventures in pump vacationing, he mentioned that variations in your basal rates might mean breaking out the NPH. Despite the nickname "Not Particularly Helpful," Gary says, "If the usual basal program has a significant peak to it, it is best to use a combination of Lantus and NPH. If there's not much of a peak, Lantus alone should do the job." My basal rates don't have a significant peak, so it doesn't look like I'll need that strategy, but it's good to know NPH is good for something!

I have to compromise more on my doses because the diabetes math isn't as precise on MDI. Yes, I can inject in whole or half units, which for a fully grown woman is usually good. But it's trickier when dealing with really precise doses. It is slightly annoying when I have to figure out whether to round up or round down when the calculator tells me to bolus 8.743 units.

Figuring out active insulin (aka "insulin on board") is almost impossible on shots. I don't know how anyone does it, and haven't really figured out a way of doing it myself other than just trying to sit back and hope my blood sugars come down by my next meal. Gary says, "We sometimes take for granted that the pump does the adjustment for us." It's important to remember that insulin does not work immediately, and depending on how often you test, you might still have some in your system you need to account for!

And last but not least: I lost a bottle of insulin. You can't lose an insulin pump. (Well, not so easily anyway...)

So... have you ever considered going on a pump vacation? If you have taken one, what was your experience? And for those of you who are contemplating switching to an insulin pump, don't let this scare you! I still fully intend to return to mine. For me, it's vastly superior in the long run, even though it isn't perfect!

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community.
The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines.
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Archived Comments

Cara|2012-04-17

I've never actively thought about it, but it's not to say I'd never do it. Like you said, ther are times it's annoying having a pump. But I'm also not willing to give up my cgms & that's what's currently attached with my pump.

Kathy B.|2012-04-17

I never have considered a vacation. I have been on a pump for 18 yrs; spending the first 17 yrs on injections. I rely on my pump and CGM to give me the feedback information even if it is less than perfect at times. The thought of having to excuse myself to go inject rather than bolusing right there at the lunch table is just not enticing. My pump just seems so much easier than carrying around needles and insulin. Also the thought of trying to figure out how much lantus etc to take just seems overwhelming when I having a decent amount of success with my pump settings. Just my perspective of course :-).

AllisonB|2012-04-17

Just a couple follow-ups: first, I don't excuse myself to inject. I do it at the table, just like I do with my pump. I try to be a little more discreet about it, but I would never leave. If people don't like it, they can look away! Second, I use insulin bottles and syringes, and they fit inside a pocket in my meter case, so I'm not carrying around anything extra. I have to bring my meter with me anyway. If I was using pens, I might feel differently. And I agree, figuring out the doses IS annoying, and that's why I don't think this will be a long-term plan for me.

Dave|2012-04-17

When I was on MDI I used to hate exercising while being on Lantus even though I split the dose it would drop me like a rock because it would absorb so much quicker. With the pump I never have that issue because there isn't that much fast acting insulin on board.

Mike (everydayupsanddowns)|2012-04-17

Having only recently joined #teampump I am sitting here nodding and smiling. All your MDI challenges are exactly what I like better about being on a pump, but the factors that prompted your pump vacation like the whole 'being attached' thing (who on a pump has not had a problem with that) do take some getting used to. Oddly I have a blog post waiting about my change from MDI to a pump which I really must get around to writing!

Michael Hoskins|2012-04-17

I've gone on a pump hiatus a couple times in the past few years, really just to give my body a break and a chance to heal. Been pumping for a decade, and I'm not always the most FDA-compliant as far as site rotation. So some months of being unconnected offered a nice little break, despite not having the same kind of flexibility a pump offers. I actually lowered my A1c pretty significantly during that time, mostly because of the diligence in keeping track of what was needed. So, you can certainly do it! Good luck on the vacation, Allison!!

susan f|2012-04-17

You can pry my pump out of my dead cold hands.What I can't give up:microcorrections- e.g. 0.3 unitstemp basals for exercise, or impending lows that I don't want to get out of bed formicrodosing - If I calculate 4.3 units for lunch, I don't want to get 'about 4' or 'about 4.5'I'm so used to the micro lifestyle of tiny corrections and very precise boluses that I'd have a hard time adapting.I did do 24h of lantus earlier this year and ran 200+ most of that time... just not worth it to me!

AmyT|2012-04-17

I'm 6 years in and still a big fan of #teampump myself. All those memories are still fresh in my mind: of struggling with dosing corrections and struggling to work out when I didn't have any idea of IOB.I'm starting to have some "real estate" issues, however, so I could see how my skin would love a vacation sometime soon!

Erin|2012-04-17

I went back to MDI after 4 years on the pump when my Medtronic Paradigm 522 broke on Christmas Eve. I haven't looked back! Blood sugars have been so much more stable without "site issues" or "absorption issues". Using a Dexcom as my CGM. Not sure if my pump vacation is forever, but still happy almost four months later.

John|2012-04-17

I was on shots for 15 years. Switched to Minimed for another 15 years and now I recently started with Omnipod. From my experiences, I can never go backwards as I have enjoyed the level of freedom and advantages along the way. 4 shots per day was just too annoying, painful, and all the other issues with injections.Minimed was my first pump experience and it was great for awhile but it had its downsides that became too irritating and annoying; namely the tubing and 'real estate'.I wear the Omnipod on the back of my arms. I never used that area before, not even for shots. So, I hope the 'real estate' will hold up until the next 'real breakthrough' (Smart Insulin, Encapsulation, or dare I say a cure) were to become available. The AP is more of the same from an invasive technology.I too thought about vacations and once I was forced to take one for a few days; (1) - forgot pump supplies when I went on vacation, and (2) - pump died and needed to wait for a new one. If I were to take a vacation it would be for a day, going to water parks or any contact sporting events.The best way to manage this illness and preserve some quality of life it thru flexibility (IMO).

Stacey D.|2012-04-17

So you never found that bottle of insulin? Boo! Well I hope that was a one time thing during your "vacation". Having been on both the tubed pump and now the pod, I can see how being tethered to something can get old. Even if it doesn't bother you most of the time, there are still those moments. And I haven't even been pumping as long as you. But personally I don't think I could ever go back to injections. The pump just makes it so much easier all around. I hope you do enjoy it while it lasts and maybe even figure out those morning fasting BGs!

Judi|2012-04-17

If you have an iPhone, there are some small apps made for it by Pancreum. One will calculate IOB for you and works pretty well. Worth a try

Meg|2012-04-17

Allison,JMHO, but I can't understand the attitude that if people don't want to see you inject at the dinner table, that's just too bad for them. Needles creep lots of people out - I try to be very sensitive to that. Surely, you'd agree there are many medical procedures you'd just as soon not witness?

AllisonB|2012-04-17

I don't consider a 5 second injection to be a "medical procedure." I also don't hide my blood sugar monitoring although I am sure there are an equal amount of people who don't like blood. It's quick and relatively unseen unless you're sitting in front of the person. If I am with a friend who says or has said that they are needle-phobic, then I'll be more conscious and give them a warning so they can look away. But complete strangers? Sorry, but that goes a little far in my book.

Tim|2012-04-17

I'm with you on people getting over the fact that you're doing a quick injection. I personally think that this behavior has the potential to make us a more-visible minority. In fact, I think it would be really interesting for there to be a day a year that EVERYBODY takes a vacation from the pump and injects themselves instead. Perhaps T1 diabetes day? It would be an excellent way for people to get an idea of how many of us are out there and that we're not going away any time soon.

Sir Lunch|2012-04-17

i've taken the odd vacation here and there, but only for a day or two....the weekend at most.....I just can't offer a valid rebuttle to all the freedoms and reasons that make pump therapy that much better.....better is better, hands down!Good luck, and stay healthy!Sir Lunch

Scott|2012-04-17

Wow, I'll jump in on the comment "trying to figure if I need to round up or down when calculator says 8.763 units...." Really - do you think you measured the carbs so accurately that the difference between 8.5 units and 9 units is significant? And that you know exactly how much you will be walking vs. sitting over the next few hours? Or whether someone is going to say something to stress you out during that time?Sorry to vent, but this comes from a doctor (who is supposed to have a basic education?) yelling at me in the hospital about having a tiny air bubble in the syringe when getting ready to take my 20 unit Lantus shot. I patiently explained the math....assuming it was as large as 1/2 a unit (which it wasn't....)...1/2 a unit spread over 24 hours amounts to a whopping 1/48th unit per hour. Since I dose 1 unit insulin for 6 grams carbs, this amounts to 1/8 gram of carb per hour...show me a scale that's that accurate. Or a meal. Or my body...With all due respect, I think too many diabetics spend way too much time worrying about "rounding error" type issues. I'm guessing taking your insulin shot before you eat would have much bigger impact than whether you round to 8.5 or 9. (Round to whole numbers...you can't measure carbs accurately enough to get to 1/2 units anyways).In my opinion of course!Scott

AllisonB|2012-04-17

Hi Scott! Thanks for your note! I agree, that in most cases it is not an issue for me at all. As I mentioned, I'm a grown woman and an extra half unit is unlikely to cause a problem. That's why I said it's only slightly annoying. But I still have to take the time and figure out which one to do! On the pump, it's all button pushing which takes some of decision-making out of the equation. It's kind of nice!

Natalie ._c-|2012-04-18

I read your post, and I thought I could have been writing it myself. I've been pumping for 13 years (only shot for 5 years), and I've taken a few pump vacations, but they've been very short-lived. It feels good to go naked for a day or two, and have nothing plugged into my belly, but the fact is that I hate shots, I'm lousy at calculating carbs in the first place, let alone taking into account IOB, and I get paranoid about my BGs are doing. And it occurs to me that by taking a pump vacation, what I'm really trying to do is take a diabetes vacation, and that just doesn't work. So for me, the end result is that I think the pump is LESS work than shots, although they always tell you it's more, and I would really hate to have to go back to shots permanently.

June S.|2012-04-18

I had considered a pump vacation, because I thought my sites had stopped absorbing. I tweaked my basal doses, and realized I still have enough adequate sites - for the moment. I would NEVER EVER consider giving up my CGM (currently integrated with my MM pump) and when my pump broke for 2 days last year, I did MDI while wearing the empty pump so that I could continue using the CGM. I would like to warn John (above) that if he wears his OmniPod exclusively on his arms, he will be in trouble soon! Put it somewhere else. I tried the OmniPod for one year, and had a combination of adhesive sensitivity (I have sensitive skin) and site problems. I've found site problems easier to address using the MM pump, since the smaller infusion set can fit in more places on my skinny body. I can also see whether the Paradigm Silhouette cannula is still under my skin, or whether I've hit a blood vessel, because of its little window. Anyway, I did 35 years of MDI before switching to the pump 5 years ago, and had better A1C's (never ever above 6.5,) but far more hypoglycemic episodes than I do now.) June

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